SUMMARY LIST OF EMERGENCY DRUGS - Best Dental CE



Emergency Preparedness Policies and ProceduresPractice Name:SAMPLEPractice Address:__________________________________________________________________Doctor’s Name:_________________________________Preface for ALL STAFF:Dear Staff Members:Please take some time to review this manual. Periodic training will be provided on the protocols outlined in this manual. The most important aspect in any training is repetition. Our goal is to practice to perfection so that, in the event of an emergency, all we have to do is execute. By repetition, execution will be smooth and efficient. If you have any questions at all, please feel free to approach _____________________________ (Doctor’s Name), and I will gladly review any areas to assure you feel competent and confident. Emergency Preparedness Officer: _____________________________________(Doctor’s Name)SUMMARY LIST OF EMERGENCY DRUGS(KIT LOCATED IN CRASH CART/MEDICAL EMERGENCY KIT)Health First SM30 ?Emergency Kit For Adult and Children Nitroglycerin spray 0.4mg/spray 60 doses (x1)Epinephrine auto-injector - pediatric 0.15mg (x1)Epinephrine auto-injector - adult 0.3mg (x1)Auto-injector training unit (x1)Back-up epinephrine 1:1000 1mg/1mL, 1mL (x2)Diphenhydramine 50mg/1mL, 1mL (x2)Albuterol inhaler (x1)Ammonia inhalants (x3)Oral glucose gel (x1)Aspirin 2 - pack (x2)Naloxone HCl nasal spray (x2)Syringes 1cc with 20G x 1.5 in needle (x2) - to draw up medications and provide IM injectionsCPR shield (x1)Medication instructions (x1)Additional if administering Level 1 Minimal Oral Sedation in OfficeFlumazenil 0.1mg/ml, 10 ml (x1)***Auto-Replenishment Service is arranged upon expiration date*** Nausea and VomitingNausea may be caused by: Empty stomachNitrous oxideSedation medications---------------------------------------------------------------------------RESPONSE if due to empty stomach:Give pt popsicle or juice to get sugar levels upRe-evaluate-----------------------------------------------------------------------------------------------RESPONSE if due to nitrous oxide: Turn nitrous oxide offAdminister 100% oxygen for 5-10 minutesIf no improvement, give juice or popsicle to get sugar levels up-----------------------------------------------------------------------------------------------RESPONSE if due to sedation medications:Turn patient sidewaysChin down, suction airwayAdminister 100% oxygenIf no improvement, may be possible aspiration (see aspiration guide)Acute Asthma Attack (Bronchospasm)Signs:Shortness of BreathWheezingCoughingChest tightnessCyanosisTachycardiaRESPONSESit upright or in comfortable positionAdminister oxygenAdminister bronchodilator If bronchodilator ineffective or the patient loses consciousness, activate EMS response and administer epinephrine1390650354330Airway ObstructionSigns a patient is experiencing airway obstruction:AgitationTurning blueConfusionDifficulty BreathingWheezingRetractionsUnconsciousRESPONSEPlace patient in supine position Clear airway manually Administer oxygen via Bag Valve Mask to take over breathingIf condition doesn’t improve, activate EMS responseContinue attempting airway rescue using appropriate airways if needed until EMS arrivesChange in Intended Sedation LevelSigns a patient is beyond moderate sedation:No response to verbal commandsResponds purposefully to tactile/painful stimulation only after multiple repeated painful stimulationEyes appear to roll backOxygen desaturationRESPONSE – GOOD AIRWAY IS MOST IMPORTANTTurn OFF Nitrous, flush bag and fill with 100% OxygenJaw thrust and chin tilt while delivering oxygenAttempt painful stimulation (posterior mandible pressure)If pt appears to become more easily arousable, continue with OxygenIf pt continues to appear deeply sedated, maintain airway, administer reversal agents, monitor recovery 2 hours afterEnsure no objects obstructing airwayContinue Oxygen, and add positive pressure if necessaryIf no improvement or patient stops breathing on their own, USE AMBUBAG to administer oxygen and activate EMS Response141922518161000LaryngospasmLaryngospasm is when a person’s throat (larynx) goes into spasm and doesn’t allow oxygen to go to lungs. Most laryngospasms can be broken with airway positioning and positive pressure oxygen. Signs of laryngospasm:Increased effort to breatheOxygen desaturationPossible bradycardia (decreased heart rate)Tracheal tugInspiratory wheezingRESPONSEClear airway of debrisOpen the airway, perform mandible pull Use positive pressure (BVM) oxygen (100%) to break spasmIf no improvement, activate EMS response Continue attempting airway rescue until EMS arrivesUrticaria (Mild Allergy)Signs of Urticaria:Itchy, raised skinHivesSwellingRESPONSE UrticariaDiscontinue all sources of allergensDiphenhydramine (Benadryl) age appropriate doseIf no improvement, administer epinephrine OR if sedation meds on board, MUST administer EPI as Benadryl will increase depth of sedationIf no improvement, activate EMS responseAnaphylaxisSigns of Anaphylaxis:- Flushing- Wheezing- Difficulty breathing- Bronchospasm- Laryngeal edema- Weak pulse- Low blood pressure- UnconsciousAnaphylaxis is a severe allergy and requires IMMEDIATE action, otherwise the airway may swell up, close, and impede breathingRESPONSE AnaphylaxisSupine position, clear airwayOxygen, may be necessary to ventilate manuallyAdminister epinephrineAdminister diphenhydramine (Benadryl) IMActivate EMS responseCPR if necessary until EMS arrives-28575030162500295021031115000Syncope – FaintingAIRWAY #1 CONCERNSigns:Feeling warmthSkin moist/paleAt first rapid pulse, then slow and weakDizzinessHypotensionCold extremitiesNauseaVomitingUnconsciousRESPONSE Lay patient supine to manage airwayOpen airway for patencyAmmonia inhalantAdminister supplemental oxygenCold towel on back of neckPositive pressure ventilation, if necessary Assess vitalsElevate feetIf no improvement, activate EMS responseConvulsions – SeizureThe most important thing to remember is to keep patient safe and prevent self-injury. Most seizures will not last very long.Signs:Warning auraDisorientationBlinkingBlank stareUncontrolled muscle movementDizziness/ConfusionRESPONSE Maintain airway, suction after the convulsionPrevent patient from biting tongue, protect your handsIf status epilepticus or lasting > 5 min, administer diazepam, call 911Activate EMS ResponseAngina Pectoris (Chest Pain)Chest pain in an adult can indicate several things, but the most important/ominous is that it can be an early sign of impending myocardial infarction (heart attack).Signs:Chest pain that is significant but not severe (can last up to 20 min)Chest fullnessBurningTightnessDyspnea diaphoresisTypically not the patient’s first time experiencing this type of painRESPONSEStop the procedureSemi-reclined position, ACTIVATE EMS responseNote time of onsetNitroglycerin sublingually, repeat if necessaryProvide supplemental oxygen if necessaryContinue to attempt to stabilize patient until EMS arrivesAspiration (contents in lung)Signs of aspiration: CoughingDifficulty breathingChokingRESPONSE:Turn sideways, evaluate airway, suction throatHeimlich if actively chokingIf unable to obtain contents from airway, administer 100% oxygenActivate EMS ResponseIf patient becomes unconscious, gently lay on floor, initiate CPR and continue until EMS arrives*If a dental instrument, crown, or other item is lost in oropharynx and item cannot be located, send patient to nearest medical facility with radiology capabilities for chest radiograph.Hyperventilation (Panic attack)Signs of hyperventilation: Rapid breathing, deep at first, then shallowIncreased heart rate (tachycardia)PalpitationsWeaknessFeeling of “tight” chestDizzinessRESPONSETerminate procedurePosition for comfortCalm patient, attempt to slow breathing by having them focus on a pen light or counting breathsHave patient breathe in and out while cupping their hands around their mouth.DO NOT administer oxygen!!!If no improvement, activate EMS responseHypertension (High Blood Pressure)Signs of HypertensionHigh blood pressureRESPONSEPosition patient for comfortMonitor vital signsAdminister oxygenConsider administering nitrous oxideIf no improvement, activate EMS responseHypotension (Low Blood Pressure)Signs of hypotensionFatigueDizzinessLightheadedNauseaClamorBlurry visionUnconsciousRESPONSELay supine to manage airwayOpen airway – keep patentAdminister supplemental O2Positive pressure ventilation, if necessaryAssess blood pressure and pulseElevate feetIf no improvement, activate EMS responseBLS protocols until EMS arrivalHypoglycemia (Low Blood Sugar)Signs of hypoglycemia:Excess sweatingHungerLightheadedFeels faintShakySlurs speechUnconscious (passing out)RESPONSE – Conscious patientAdminister glucose tablets, one tube of glucose gel or juice/soda Evaluate responseIf unimproved, activate EMS responseRESPONSE – Unconscious patientActivate EMS response immediatelyDO NOT GIVE INSTAGLUCOSE – it can clog airwayBLS protocols until EMS arrivalSudden Cardiac Arrest (Stopped Breathing)Signs:Unconscious and without a pulseRESPONSEActivate EMS response immediatelyInitiate rapid defibrillation of the heart using an AEDEarly BLS protocolsMyocardial Infarction (Heart Attack)Signs of HypertensionRadiating pain down left side of bodyPain in upper chestPain between shoulder bladesPain in backPain in jaw (mandible)Pain in armImpending sense of doomRESPONSE – INITIATE BLS/ACLS protocolMedical assistance, call 911Note time of onsetRecord vitalsChewable aspirin 4x81 mg Be prepared for CPREMS RESPONSEIn event of ANY emergency, get Doctor’s attention immediately.STAY CALMDoctor will ASSIGN ROLES – very important to follow role assigned.ROLES & DutiesEMS activatorCalls 911, serves as communication liaisonDrugs RetrieverRetrieves and draws medications as doctor instructsAirway ManagerAssures that patient’s airway is patentAED RetrieverGets AED, clears field, and preps patient’s chest for AEDRecorderRecords time based record of sequence of events, drugs administered, and vital signsEMS LiaisonClear hallways and rooms for EMS accessOnce Doctor has assigned roles, proceed to follow duties assigned to that roleAfter airway management and drug options have been exhausted, CPR may need to be initiated. If patient progresses past CPR sequence, then chest compressions initiated, and Doctor + Airway manager will switch off compression roles*ALWAYS USE CLINICAL JUDGMENT: IF DR NOT IN IMMEDIATE VICINITY AND YOU RECOGNIZE AN EMERGENCY, PROCEED WITH RESCUE PROTOCOL. CPR TipsIF you identify a patient in distressYell for HELP, check pulse while attempting to engage patientIf no pulse, initiate CPRIF EVER respiratory rate or heart rate = ? resting rates, BEGIN CPR with airway/BVM and chest compressionsHead tilt-chin lift to open airway unless cervical spine injury suspected – CAUTION against hyperextending infant necksCardiac arrest with agonal gasps BEGIN CPRAdult with chest pain – CALL 911Proper technique: Good rate, depth, and full chest recoilNo pulse CHEST COMPRESSIONS immediatelyEarlier defibrillation = Higher survival rateIf choking victim becomes unresponsive lay on floor, initiate CPR, check for object between breathsNO MORE HEIMLICH once unconsciousNO BLIND FINGER SWEEPSMinimize interruptions between compressionsCALLING 911REMAIN CALMGive location (office address)Give phone number (identify land line or cell phone)Inform operator of medical emergencyInform whether patient is conscious or unconscious Details of incidentExplain current interventionInform operator who the assigned EMS liaison is and best route into facilityAsk how long for EMS to arriveStay on phone until instructed otherwiseInform Doctor of any pertinent updatesMEET EMS personnel at designated entrance with EMERGENCY TREATMENT RECORD and convey all pertinent informationCompression to Ventilation RatiosAgeSingle RescuerTwo RescuerHand PlacementCompression DepthAdult30:230:22 Hands Lower ? of breastbone (sternum)At least 2 in (5 cm)Child (1-8)30:215:22 hands or 1 on lower ? of breastboneAt least 1/3 A-P diameter of chest~(2 in or 5 cm)Infant (<1)30:215:21 rescuer: 2 fingers center of chest below nipple line2 rescuers: 2 thumbs encircling hands in center of chest below nipple lineAt least 1/3 A-P diameter of chest ~(1.5 in or 4 cm)Emergency Treatment RecordPt Name: ______________________ Date: ___________ Time: __________Pt Age: ______________________ Pt Weight: ______________________Pt Gender: ______________________ Allergies: ______________________Meds taken/administered prior to emergency: ________________________________________TimeBPPulseRRO2 SatO2 Flow L/minMeds AdministeredMed DosageMed RouteTime Called 911: _______________________Time EMS Arrived: _____________________Hospital transported to: __________________________________________________________Condition of pt at time of transportation: ____________________________________________EMS Personnel: _________________________________________________________________Office staff present: _____________________________________________________________Name of Recorder: __________________________Date: __________________________Signature: __________________________ ................
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